The Food and Drug Administration (FDA) has approved a number of medications and treatment options for individuals struggling to manage bipolar disorder. On Dec. 1, the organization issued a set of FDA guidelines to help patients better understand the condition, in addition to a set of guidelines for identifying and treating depression.

What is Bipolar Disorder?

Bipolar disorder is a brain condition characterized by shifts in chemicals, which cause changes in mood and behavior. There are two types of bipolar disorder: type I and type II. The FDA asserts the importance of diagnosis for proper treatment.

Bipolar I, also referred to as manic depression, involves deep states of depression followed by manic energy. Bipolar I is characterized by “unusual shifts in mood, energy, activity levels, and the lack of ability to do everyday tasks.”

People with bipolar II experience a less intense form of hypomania, known as a manic episode. During the hypomania stage, individuals can be extremely productive and exhibit no symptoms of depression. However, bipolar II patients may rapidly drop into a depressive state.  

Symptoms of depression include:

• Feeling very sad or hopeless
• Lack of energy or motivation
• Feeling like you can’t enjoy anything
• Suicidal ideation

Symptoms of mania include:

• An elevated or irritable mood
• Increased activity and restlessness
• Racing thoughts or talking fast
• A decreased need for sleep

“A doctor can complete a medical history, physical exam, and laboratory exam to rule out physical conditions that may cause similar symptoms,” according to Mitchell Mathis, M.D., director of the Division of Psychiatry Products at the FDA. “If symptoms are not caused by other illnesses, the doctor may then provide a referral to a mental health professional.”

Depression Differences

The FDA also published a guideline to understanding depression, which differs from bipolar disorder. Depression, also known as “major depressive disorder” or “unipolar depression,” is characterized exclusively by low periods, whereas bipolar disorder involves elevated and energetic states.

Depression affects 350 million people worldwide, according to the World Health Organization.

Symptoms of depression include:

• loss of interest or pleasure in almost all activities
• changes in appetite or weight
• disturbed sleep or sleeping too much
• slowed or restless movements
• fatigue or loss of energy
• feelings of worthlessness or excessive guilt
• trouble in thinking, concentrating, or making decisions
• thoughts of death or suicide

Bipolar Treatment: Pharmaceuticals

Instability of mood caused by bipolar disorder can be treated with various pharmaceuticals that belong to different medication families. The FDA classifies bipolar medications in two categories, including:

• mood stabilizers, which help balance certain brain chemicals to prevent mania, hypomania, or depressive episodes
• antipsychotic drugs, which include relatively newer drugs called “atypical antipsychotics”

However, many of these treatment options come with a number of side effects. The FDA lists “nausea, trembling, and increased thirst” as side effects of mood stabilizers and “sleepiness, dizziness, and feeling restless” stemming from antipsychotics.

Depression Treatment: Pharmaceuticals

Antidepressants exist within different classes of medications that target the brain’s neurotransmitters of serotonin, norepinephrine, and dopamine. The FDA lists mood-regulating antidepressant classifications, which includes:

• selective serotonin reuptake inhibitors (SSRIs); examples are Prozac (fluoxetine), Celexa (citalopram), and Paxil (paroxetine)
• serotonin-norepinephrine reuptake inhibitors (SNRIs); examples are Effexor (venlafaxine) and Cymbalta (duloxetine)
• tricyclic antidepressants (TCAs); examples are Elavil (amitriptyline), Tofranil (imipramine), and Pamelor (nortriptyline)
• monoamine oxidase inhibitors (MAOIs); examples are Nardil (phenelzine) and Parnate (tranylcypromine)

Other antidepressants include:

• Remeron (mirtazapine)
• Wellbutrin (bupropion)

Treating bipolar disorder with depression medication may result in manic episodes. The agency encourages patients to inform health care providers if symptoms of manic depression arise.

Bipolar Treatment, Depression Medication Risks  

Medications used for depression and bipolar treatment come with a number of short and long-term side effects. Two popular treatments, Abilify and Paxil, can cause serious complications in some patients.

Abilify is a second-generation antipsychotic used to treat depression, schizophrenia, autism and bipolar disorder. Abilify has been linked to suicidal thoughts, compulsive behaviors, and problems with impulse control. Some individuals experience a pathological desire to binge eat, gamble, or have sex.

Paxil, a selective serotonin reuptake inhibitor (SSRI), is approved for depression, though it may be used to treat bipolar disorder. Paxil can cause a number of common side effects, such as nausea, weight gain, diarrhea, and problems with sleep or sex. When used while pregnant, Paxil may cause birth defects. Babies exposed to Paxil in utero also have a higher autism risk.

It’s crucial for patients suffering from symptoms related to depression or bipolar disorder to undergo an evaluation, receive a proper diagnosis, and continue to be monitored by a health professional. For individuals who may be in crisis, the FDA urges immediately seek medical attention:

“You can call your doctor, go to a hospital emergency room, or even call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255). This line is open 24 hours a day, 7 days a week and all calls are confidential.”